Chapter 3: Finding Relevant Evidence to Answer Clinical Questions

Chapter 3: Finding Relevant Evidence to Answer Clinical Questions

Chapter 3: Finding Relevant Evidence to Answer Clinical Questions Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answering Clinical Questions Finding the right information to answer a given question often depends on the source of the information Searching for evidence that has already been appraised

for the quality of the study methodology and the reliability of its findings is desirable Pre-appraised literature Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Tools for Answering Clinical Questions Begin with a PICOT question

Determine the source from which the best evidence is available Clinicians need peer-reviewed research Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins External Sources of Evidence Textbooks and journals

Consolidated resources Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Hierarchy of Evidence Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following sources of evidence is best able to inform a nurses clinical practice? a. A well-designed randomized controlled trial (RCT) b. A systematic review that encompasses multiple studies

c. Expert opinion of experienced and educated nurses d. A case study that addresses an unique clinical scenario Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b. A systematic review that encompasses multiple studies Rationale: Systematic reviews are considered to be higher on the hierarchy of evidence than expert opinion or individual RCTs and case studies.

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Which Resource or Database is a Good Match? Online databases Grey literature

Bibliographic versus full-text databases Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Collaboration with Healthcare Librarians Librarians are a rich source of assistance They are especially valuable when time is of the essence

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Keyword and Controlled Vocabulary Searching Keyword searching is searching using simple, everyday language Controlled vocabulary systems, e.g., MeSH

Normally have a hierarchical structure that helps the searcher retrieve the more specific terms that fall under a general term Most large bibliographic databases (MEDLINE, CINAHL, and PsycINFO) use a controlled vocabulary to describe the content of references Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question

Tell whether the following statement is true or false. A controlled-vocabulary system may yield fewer hits than a keyword search, but these hits are more likely to be relevant to the clinical question. Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer

True Controlled vocabulary systems exist to increase the relevance of search results while limiting the number of less-relevant hits. Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Combining and Limiting Searches

Combining search terms from within a PICOT question focuses the search results Consider that different search engines process terms in the search box in different ways Using the limit function is designed to help the searcher pare down the large results list Manage inclusion and exclusion criteria carefully Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Online Searches

Managing citations Saving searches Organizing searches Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Selecting Databases: Cochrane

Databases A collection of 6 different databases Gold standard database is the Cochrane Database of Systematic Reviews (CDSR) Systematic reviews are based on critical appraisal Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Selecting Databases: National Guideline Clearinghouse A comprehensive database of evidence-based clinical practice guidelines Guidelines are systematically developed statements about a plan of care for a specific set of clinical circumstances involving a particular population Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Selecting Databases MEDLINE - covers medicine, health, and the biomedical sciences CINAHL covers 13 nursing and allied health disciplines EMBASE - major European biomedical and pharmaceutical database

PsycInfo covers psychology, behavioral sciences, and mental health Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following online evidence sources is most likely to provide pre-appraised evidence? a. CINAHL b. MEDLINE c. PubMed d. Cochrane Library Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer d. Cochrane Library Rationale: The Cochrane Databases consist of systematic reviews that synthesize evidence from multiple peerreviewed sources. CINAHL, MEDLINE, and PubMed may contain evidence at a synthesis level, but are more often sources of individual articles that a nurse must appraise. Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Specialized Search Functions PubMed Ovid EBSCO Any search for evidence must be followed by critical appraisal

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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